A study of supplements that claim to lower cholesterol followed 199 patients at the Cleveland Clinic for 28 days. Participants were given either a supplement (fish oil pills, red yeast rice, cinnamon, garlic, turmeric or plant sterols), a statin drug (rosuvastatin, brand name Crestor, 5 mg/day) or a placebo (Journal of the American College of Cardiology, Nov 6, 2022). The participants were 40-75 years old, had LDL cholesterol levels between 70 and 189 mg/dL, had not been taking drugs or supplements to lower cholesterol, and had no history of heart disease.

The statin drug reduced the bad LDL cholesterol by 35.2 percent. None of the supplements lowered blood levels of LDL cholesterol more than placebo, and adverse side effects were the same for all groups The garlic pills increased LDL cholesterol by 7.8 percent over placebo.

Other supplements that have not been shown to effectively lower high cholesterol include:
• Selenium (Ann Intern Med, 2011 May 17;154(10):656-65).
• Calcium (Ann Intern Med, 2011 May 17;154(10):656-65).
• Policosanol extracted from sugar cane (JAMA, 2006 May 17;295(19):2262-9).
• Coconut water (Nutr Rev, 2013 Dec;71(12):822-35).
• Soy isoflavones (J Nutr, 2019 Jun 1;149(6):968-981).

The $50 billion/year supplement industry is not regulated by the U.S. government because of a law passed by Congress in 1994 that forbids the FDA from regulating food, and these supplements are sold as foods.

How Fiber Helps to Lower LDL Cholesterol
Soluble fiber blocks cholesterol absorption (Nutrients, Sept 2018;10(9):1262), so fiber supplements should be able to make the claim that they are effective for lowering cholesterol. However, you will get far more fiber just by eating a wide variety of plants in a healthful plant-based diet rather than taking fiber pills or powders.

All plants contain soluble fiber that is not absorbed until it reaches the colon, where healthful bacteria convert the soluble fiber into short chain fatty acids (SCFAs). SCFAs are absorbed from the colon into the bloodstream, where they lower high cholesterol, high blood pressure, high blood sugar and inflammation (J Lipid Res, Sept 2013;54(9):2325-40). See Fiber Wins Again
More Fiber from Whole Foods is Better

My Recommendations
A blood level of the bad LDL cholesterol greater than 100 mg/dL is associated with increased risk for heart attacks and premature death. Everyone should be on a heart-attack-preventing program, especially if your LDL cholesterol is greater than 100 mg/dL.
• I recommend a cholesterol-lowering diet that restrictis meat from mammals and processed meats, sugar-added foods, fried foods, and all drinks with sugar. Your plant-based diet should include a wide variety of vegetables, fruits, whole (unground grains), beans, nuts and other seeds.
• Try to exercise every day. If you do not exercise regularly, check with your doctor and see How to Start an Exercise Program
• Avoid smoking and alcohol
• Lose weight if overweight
If you are not able to get your blood cholesterol level down with lifestyle changes, your doctor may recommend taking statin pills. See Statins and Alternatives